87191A - Gore, Robert and Jodi

❑CAMA ❑ DREDGE & FILL N9 87191 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑New []Modification []Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. Q General Permit Rules available at the following link: www.dea.nc goy/CAMArules
Applicant Name _
Address
City State
Phone # ( )
Email
ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
chnrclinn I ength
Authorized Agent ! /'G-Y.;^ I,
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale:
Access Length
--
-_
__._
Pier (dock) length -
l
y
(
x
u
Fixed Platform(s)
Floating Platform(s)
!
-
Finger pier(s)
_
Total Platform area
I
-
"
V
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
1
1
I
—
I
I
,—
I
—
---
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/Boatlift
—
..
4
Beach Bulldozing
Other
_
_
_
-�
_
_
_
_
r
J
—,
SAv observed: yes no
.
Moratorium: n/z ` yes no
Tip
�;
'
tr
ti-
4A.
`
Site Photos: yes: no
Riparian Waiver Attached: yes no
I
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A building permit/zoning permit may be required by: (
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit**
Application Feels) Check #/Money Order
Signature
Cf�(.
Issuing Date Expiration Date

CNine of Property Owner Requesting Permit:�
Mailing Address: Iaa(� SCY/hvit�{1f)90 (�
Phone Number: qlq- 598a
Email Aftess: p Ua?0 7�a
Qma+.O Pom
i certify that I have authorized Q, jZ. + r �LQ,p4r1��COCsmn r/�a i '
VU Agent / Contractor
to act on my behalf, for the Purpose of applying for and obtaining all CAMA permits
nftBsmry for the following Proposed development
at my Property located at male SOtim� i�,. ]}r Ada N o7 1
at __.L�County.
I furthermore certify that l am authorized to grant, and do in fact grant Permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
Permit application.
Property Owner Information:
Sigrratr'
�o6tr}- �,rr )o lay ,mi r
Print or fYPe Name MAY 13 2024
Prnner��I 0 iru�5 _�
Dais
This certification is valid through t t

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1 hweby certnY that I Own property adjacent to the above referenced property. The kk*#Uwh aPPlyiop brfb
P".1 has destffled to me, to shown O, the .tua,ed draw ft the dev*p mt V" am PrOOoM4 0
c� too Pror tws oDJktlont m tn+. propoMi i ao t>M ob).oeotr b thtie pvpo.al
�+eOanrNrf (DCIi� In wrftlny wtNrin 10 Nays d rsnt� dtlets noyta�CortyaponWnq should ps
40e0100d to 401 S. Or"n St, SOe. J00, EUmbefh City, NC, 27900. OCU rspragwnhWv a Can ayp be
aoe®ecied at (282) 24"001, No m*POnn It oonakhred Mesarme w no ON*cLton I yttu Arm Aaaw
weftway CartaleQAte0.
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t U"W tard Cott mY ProPOded PUt• dock MDOnnO PAW, Doaf MV. bmkwato, borhxm. R or
Oman mat be set back a aftn nth dhtaros of 15• ftm my aloe o(Apedan ICON under wahsd by no
MIS doss not appy to buWwao Or rkV p relabn(w). Of you 1rMit to wat" dw --beak you BUI&Aft
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#APO= dAd)aoert ftarMn Property Oamaf:
RECIPIVED
MAY 13 2024
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%.C. O1VkSION OF COASTAL MANAGEMENT
AOJACENT FUPARIAN PROPERTY OWNER N07IFICATIONtWAP4R FOM
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AWnw of Proprrt)r.
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rrrpemsrrrt /ACAt/ 1n aMttrrp wkhtn !0 rdAV' of roeolpr d flue nonce. CorraAccdanea tAoi,kt eia
=We Iu lot S. OftTn SG. Sft. 300, 0066M CHy, MC„ M00. DCIN roprsran=Vw can abo Do
maakmd at (262)2$4-.7wt. No ruporre to cwwtaar+a an se►» as no oblocum A, you hm been
gat and &y Card AItL
I trtt7a WW4 ttur. spy pmpOssd 0W. dom moonns P&W. boat mWi anotwator. LoaCwuu, a, or
pros teas' be so ae cx a m ^um CAtan�o of ' S' try r my of vsfwn avow U Vm waNw by rtta
(thks do," not a py to CUAC"80 Or r+0ra0 f#vWtnanb). (if YOU watt to wsltve Ufa 0*64k, YOU MMIUM
3ie approprtata btt+nk 00".)
I DO WUh to wstN OOMWAN CI VA If asboc►
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t do so wiit+t0 w� tS a ow* MAY � 3 2024
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